Healthcare Provider Details

I. General information

NPI: 1922920073
Provider Name (Legal Business Name): GASTON FAMILY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLEVELAND AVE
KINGS MOUNTAIN NC
28086-2508
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-476-8356
  • Fax: 704-297-4642
Mailing address:
  • Phone: 704-874-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MOLLY BROWN QUACKENBUSH
Title or Position: DIRECTOR OF CREDENTIALING AND CLINI
Credential:
Phone: 704-874-1904